Newswise — The worldwide obesity epidemic is of top concern to Dr. George A. Beller, Professor of Cardiology at the University of Virginia Health System. As he explains it, patients who are obese often have type 2 diabetes, a condition that requires special heart care.
Type 2 diabetes is the most common form of diabetes mellitus. People who have this condition are resistant to their insulin and often develop inflammation in their coronary arteries. Although type 2 diabetes commonly occurs in adults, an increasing number of overweight children and adolescents are also developing it.
Six years ago, Dr. Beller established one of the nation's first combined Diabetes-Cardiovascular Disease clinics at UVA to care for diabetic patients with suspected or known heart disease. At the clinic, a cardiologist and an endocrinologist who specializes in diabetes use a team-based approach to treat patients.
"About 70 percent of diabetics die from cardiovascular disease," notes Dr. Beller. "That's why our clinic acts as if the diabetics we treat already have some degree of heart disease, even if they have never exhibited any signs of it."
Treatment goals for diabetic patients without heart disease symptoms include reducing their LDL (bad cholesterol) to under 100, which often requires use of cholesterol lowering drugs like statins. "An LDL below 100 is the same level we aim for when treating someone who has had a heart attack," says Dr. Beller. "We also focus on getting the patient's systolic blood pressure below 135 and place them on aspirin."
When treating a diabetic patient with heart disease, cardiologists have to get "extremely aggressive," Dr. Beller says. "These people have a much greater risk of having a heart attack or dying of heart disease than someone who isn't diabetic."
Diagnostic testing is the first step in assessing diabetic patients whose symptoms suggest they may have heart disease. "Many obese type 2 diabetics who have heart disease may experience shortness of breath with exertion rather than chest pain. Such patients need to have stress testing with cardiac nuclear imaging or echocardiography to detect if they have severe blockages in their coronary arteries," notes Dr. Beller.
When heart disease is detected, cholesterol goals become even more stringent. Treatment plans focus on getting a patient's LDL under 70 and their HDL (good cholesterol) above 40.
As Dr. Beller notes, a crucial element of treatment is encouraging diabetics to make lifestyle changes that include weight loss and exercise. "Obesity is driving the epidemic of type 2 diabetes, and drugs alone will not solve the problem," he says. "Obese people who lose just ten percent of their body weight can reverse inflammation of the arteries and reverse many other cardiometabolic abnormalities."
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